Provider Demographics
NPI:1639051840
Name:LUJAN-MADRID, YAJAIRA BERENICE (LSAA)
Entity type:Individual
Prefix:MRS
First Name:YAJAIRA
Middle Name:BERENICE
Last Name:LUJAN-MADRID
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2397
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2397
Mailing Address - Country:US
Mailing Address - Phone:505-692-9952
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2397
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2397
Practice Address - Country:US
Practice Address - Phone:505-692-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2025-0002101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)